Alcohol-related Disease Research Articles

Long-term mortality risk by cause of death in newly diagnosed patients with epilepsy in Finland: a nationwide register-based study

To estimate long-term mortality by cause of death in a nationwide, register-based cohort of newly diagnosed patients with epilepsy (PWE). All noninstitutionalized Finnish PWE aged 10-74 years (n = 10,818) eligible for reimbursement for antiepileptic medication for the first time between 1990 and 1994 were identified in the database of Social Insurance Institution of Finland. Mortality was compared against a population-based reference cohort (n = 43,894). Hazard ratios (HR) and their 95 % confidence intervals (95 % CI) during a follow-up of 18 years were estimated using proportional hazards modeling. Potential years of life lost (PYLL) and excess fraction of causes of death attributable to epilepsy were estimated. PWE contributed 137,610 person-years of observation and there were 3,558 deaths. Mortality remained elevated up to 18 years post-diagnosis (HR 3.21, 95 % CI 3.07-3.35). Ischemic heart disease mortality in PWE was two-fold (HR 2.31, 95 % CI 2.09-2.54), and remained constantly elevated during entire follow-up in both men and women. Most premature mortality in terms of PYLL was attributable to brain cancer (17 %), other cancers (15 %), ischemic heart disease (11 %), as well as cerebrovascular diseases (10 %). The percentage of deaths in PWE statistically attributable to epilepsy was 3.9 % for accidents, 3.4 % for alcohol-related diseases, and 1.6 % for suicides. PWE had substantial excess mortality from non-communicable diseases, which did not disappear by 18 years. Diseases of the circulatory system and cancers, especially brain cancer, were the most important causes of death almost regardless of the mortality indicator.

Alcohol training and alcohol habits of the medical students

Background The disease burden attributable to harmful use of alcohol is significant and in many countries public health problems caused by it represent a substantial health, social and economic concern. Across Europe, there is a clear gap in act the potential health interventions to reducing the alcohol harm. In primary health care settings, commonly fewer than 10% of people at risk of becoming hazardous and harmful drinkers are identified and fewer than 5% of those who could benefit from brief interventions are offered them. The health sector workforce in Europe is an enormous resource with great potential to affect positive change in alcohol-related diseases. Aims The level of alcohol training and alcohol habitsof the medical students in the University of Catania, Italy were investigated. Methods A cross-sectional study involving 5th year medical students was carried out. Students were recruited during lectures and a self-administrated questionnaire was used to collect alcohol training data. Alcohol habits were screened by the Alcohol Use Disorder Identification Test. Results A total of 170 students participated in the survey, aged between 22 and 30 years. 54.5% knows the meaning of "degree of alcohol". 72.0% knows the limit set by the highway code. 90.9% said that cannot recover from alcohol dependence syndrome. 15.9% of students think that a person must be an alcoholic to have health problems derived from alcohol. 80.3% of students know that drinking alcohol affects driving. The 87.9% know that alcohol causes intoxication stronger when mixed. 30% of the students are aware that in Italy the sale of alcoholic beverages is prohibited for children under 18 years. Harmful alcohol use was more prevalent among male (4.5%) than female students (3.0%).Hazardous drinking was found in 0.8% of studied subjects, more among men than women. Conclusions This study highlights the need for a greater and more relevant focus of alcohol education to medical students.

Hepatitis C Viral Infection Increases the Risk of Dementia

Background: Hepatitis C virus (HCV) infection produces a chronic systemic disease. In addition to its effects to liver, patients with chronic HCV infection may exhibit fatigue, depression, reductions in their quality of life and cognitive impairment. HCV infection may cause cognitive impairment, but no studies have focused specifically on cognitive impairment stemming from dementia. Aims: The purpose of this study was to investigate the potential increased risk for dementia in HCV-infected patients. Methods: We conducted a population-based cohort study based on the Taiwan National Health Insurance Research Database. From all potential participants aged fifty years or more, a total of 58,570 matched (1:1) pairs of HCV-infected patients and non-HCV-infected patients were included. Each subject was individually tracked from 1997 to 2009 to identify incident cases of dementia (onset in 1999 or later). Cox proportional hazard regressions were employed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between HCV infection and dementia in the HCV-infected cohort. Results: There were 3,291 cases of dementia reported in the HCV cohort during a follow-up period of 552,067.4 person-years with an incidence rate of 59.6 cases per 10,000 person-years (95% CI, 57.6-61.7). The multivariate-adjusted HR for dementia was 1.21 (95% CI, 1.15-1.27) for HCV-infected patients. Age subgroup HRs (95% CI) for dementia were 1.38 (1.23-1.55), 1.30 (1.20-1.39), 1.24 (0.14-1.36) and 1.51 (1.13-2.04) for participants in their fifties, sixties, seventies and eighties, respectively. There were 2,298 HCV-infected patients (4.0%) who completed antivirus therapy. The HR of treated patients was 0.98 (95% CI, 0.74-1.31) after adjusting for alcohol-related disease, liver cirrhosis and hepatic encephalopathy. Conclusions: HCV infection may increase the risk for dementia. HCV antiviral therapy may lower the risk of dementia in HCV-infected patients.

Alveolar Macrophage Dysfunction and Chronic Alcohol Use. Time to Think about Zinc

As the resident professional phagocyte in the lungs, the alveolar macrophage plays a central role in the maintenance of alveolar homeostasis, lung host defense, and immune regulation. During health, the alveolar macrophage operates both as an antiinflammatory effector cell that silently removes particulate debris and microbial organisms from the air spaces, and as a sentinel that initiates inflammatory responses when host defense systems are overwhelmed. During inflammation the role of the alveolar macrophage further expands to include clearance of apoptotic cells from sites of injury and initiation of antiinflammatory and tissue repair programs. A growing body of evidence suggests that chronic ingestion of alcohol impairs many of these essential functions, including phagocytosis of bacteria and ingestion of apoptotic cells. It is therefore not surprising that chronic alcohol use places individuals at increased risk for pneumonia and development of acute respiratory distress syndrome (ARDS) (1, 2). In this issue of the Journal, Mehta and colleagues (pp. 716–723) add to their previous work on alcohol-related lung disease by systematically characterizing alveolar macrophages isolated from individuals with alcohol use disorder and carefully matched control subjects (3). In doing so, they highlight important mechanisms that underpin alveolar macrophage dysfunction in the alcoholic lung. These include intracellular zinc deficiency, altered redox state, and impaired signaling through the granulocyte–monocyte colony–stimulating factor (GM-CSF) receptor.

OP82 Ethnic Differences in Alcohol-Related Diseases in Scotland

BackgroundAlcohol-related harms, most commonly liver disease-related, are a public health priority in Scotland. Previous research has identified variations in liver disease mortality endpoints using country of birth as a proxy...

PP058-SUN ENTEROCUTANEOUS FISTULAS OF THE SMALL BOWEL: TREATMENT BY CHYME REINFUSION

event in alcoholic and cystic fibrosis conductance regulator (CFTR) related disease. We therefore investigated FFA profile and inflammatory changes in CP associated with alcohol consumption (a-CP) and CFTR mutations (c-CP). Methods: 17 patients (12 patients with alcoholic chronic pancreatitis, 5 patients with CFTR-associated pancreatitis without obvious signs of steatorrhea) and 9 healthy controls were tested by gas chromatography for profile of free plasma fatty acids (FFA). Clinical characterization was performed and proinflammatory cytokine activity measured by soluble tumor necrosis factor receptor (sTNFR-75). Results: CP patients were characterized by an increased fraction of arachidonic (20:4 n-6) acid (9.8±0.6% vs. 7.5±0.65%, p < 0.02), a decreased fraction of linoleic acid (22.9±1.2% vs. 29.5±0.8%. p < 0.003) and a decreased linoleic/arachidonic acid ratio (2.5±0.17% vs. 4.2±0.39%, p < 0.002). Eicosatrienoic acid (ETA, C20:3 n-9, Mead acid) was increased in c-CP compared with a-CP and controls (0.71+0.2 vs. 0.19+0.18 vs. 0.12+0.15; p < 0.05). No difference between groups was shown for inflammatory activity (sTNFR-75: 2495±152 vs. 1928±231, n.s.), but sTNFR-75 levels were inversely related to eicosatrienoic (20:3 n-9) acid (r = 0.66, p < 0.001) Conclusion: CP is characterized by a proinflammatory FFA pattern often accompanied by deficiency of essential fatty acids. This FFA profile may be a factor in pancreatic damage and could present a target for new therapeutic strategies in CP treatment

Demographic, socioeconomic, disease history, dietary and lifestyle cancer risk factors associated with alcohol consumption

Data are lacking regarding the association of alcohol consumption with a broad range of other cancer risk factors. (i) to assess which sociodemographic, lifestyle and dietary factors were associated with alcohol consumption; (ii) to identify profiles of alcohol consumers by beverage type; (iii) to estimate the number of cancer risk factors accumulated on the individual level according to alcohol consumption. Alcohol and dietary intakes were assessed by six 24 hr records among 29,566 adults of the NutriNet-Santé cohort. Factors associated with alcohol consumption (nondrinkers (reference)/< 10 g/day/≥ 10 g/day) were assessed by polytomic multivariate logistic regression stratified by gender. Among alcohol consumers, percentages of alcohol brought by each beverage type were compared across sociodemographic and lifestyle characteristics using Kruskal-Wallis rank tests. Several factors were associated with alcohol consumption ≥ 10 g/day in both genders: older age (p(men)=0.02, p(women)<0.0001), smoking (p(men&women) < 0.0001), higher socioprofessional category (p(men&women)<0.0001), higher income (p(men)=0.003, p(women)<0.0001) and less healthy dietary intakes. Profiles of subjects varied across alcoholic beverage types. Men with history of cardiovascular disease (p=0.0002) or depression (p=0.03) and women with history of cirrhosis (p<0.0001) consumed less alcohol. In women, personal history of cancer was associated with a lower proportion of moderate alcohol users only (< 10 g/day, p=0.04). In both genders, higher alcohol drinkers clustered more cancer risk factors (median=5, apart from alcohol) than nondrinkers (median=4), p< .0001. The multiplicity of deleterious lifestyle behaviors combined with alcohol drinking must be taken into account in cancer prevention efforts. Gender-specific medical advice for people with personal or family history of alcohol-related diseases, including cancer, should be strengthened.

Defining, quantifying, and characterizing adult frequent users of a suburban Canadian emergency department

Frequent emergency department (ED) users are inconsistently defined and poorly studied in Canada. The purpose of this study was to develop uniform definitions, quantify ED burden, and characterize adult frequent users of a suburban community ED. We retrospectively reviewed the administrative database of the WestView ED in Alberta for patients ≥ 18 years of age presenting during the fiscal year of 2010. Adult frequent users and extreme frequent users were defined as patients with yearly visit numbers greater than the 95th and 99th percentiles, respectively. Demographic information including age, sex, ED length of stay, diagnoses, Canadian Triage and Acuity Scale (CTAS) level, and disposition were collected and stratified by ED frequency of use categories. The study included 22,333 ED visits by 14,223 patients. Frequent users represented 3.1% of patients and 13.8% of visits. Extreme frequent users represented 0.8% of patients, 5.4% of visits, and 568,879 cumulative ED minutes (395 days). Nonfrequent users had one to four, frequent users had five or more, and extreme frequent users had eight or more visits over a 12-month period. Frequent users and extreme frequent users had a significantly longer ED length of stay overall and in most age categories. Alcohol-related behavioural disorders, anxiety, nausea/vomiting, and chronic obstructive pulmonary disease were prominent diagnoses, suggesting that psychiatric, somatic, and chronic illnesses may underlie recurrent visits. Admission rates were significantly higher for frequent compared to nonfrequent users. We propose reproducible definitions for adult frequent and extreme frequent ED users and provide information on the characteristics and burden of care of these groups at a community Canadian suburban ED. Adoption of these definitions would allow comparison across centres in future research and facilitate targeted interventions for frequent and extreme frequent ED users.

Drinking Patterns Among Korean Adults: Results of the 2009 Korean Community Health Survey

ObjectivesIn Korea, the proportion of deaths due to alcohol is estimated at 8.9%, far exceeding the global estimate of 3.8%. Therefore, this study was performed to examine the factors associated with low-risk, moderate-risk, and high-risk drinking patterns in Korean adults and to identify target populations for prevention and control of alcohol-related diseases and deaths.MethodsWe analyzed data from 230 715 Korean adults aged 19 years and older who participated in the 2009 Korean Community Health Survey. Multinomial logistic regression analysis was used to examine associations between socio-demographic and health-related factors and patterns of alcohol use.ResultsA substantially larger proportion of men than women engaged in high risk (21.2% vs. 3.4%) and moderate-risk alcohol use (15.5% vs. 8.2%). In both sexes, moderate- and high-risk uses were associated with younger age, higher income, being currently employed, smoking, being overweight/obese, and good self-rated health.ConclusionsGiven the large proportion of the population that is engaging in moderate- and high-risk drinking and given the social norms that support this behavior, public health policies and campaigns to reduce alcohol consumption targeting the entire population are indicated.

Analysis of Ethanol Effects on Corneal Epithelium

Ethanol is widely used in ocular surface surgeries and for the treatment of corneal diseases. However, ethanol is a toxic agent that is related to the development of a number of alcohol-related diseases. Despite the common use of ethanol for therapeutic purposes in ophthalmology, effects of ethanol on the ocular surface have been poorly defined. Hence, we performed this study to investigate effects of ethanol on corneal epithelium from various aspects. We exposed corneal epithelial cells in culture to different concentrations of ethanol for 30 seconds and evaluated the cells for toxicity, survival, and expression of cell-specific markers and inflammatory cytokines at 24, 48, and 72 hours after ethanol exposure. We found that ethanol markedly decreased the viability of cells in a concentration-dependent manner by causing cell lysis, suppressing proliferation, and inducing apoptosis. Also, expression of corneal epithelial cell-specific markers, both stem cell and differentiation markers, was significantly reduced by ethanol exposure. Expression of proinflammatory cytokines and chemokines was highly increased in corneal epithelial and stromal cells that were exposed to ethanol. Together, data suggest that brief exposure of the corneal surface to ethanol may have long-term effects by disrupting the integrity of corneal epithelium and generating inflammation, both of which are precursors to a number of ocular surface diseases.

Risky Single-Occasion Drinking and Disadvantaged Men: Will Recruitment Through Primary Care Miss Hazardous Drinkers?

Men who are socially disadvantaged are at a substantially higher risk of developing alcohol-related diseases. People from deprived areas are known to be more difficult to recruit to research studies. As part of a feasibility assessment for an intervention study, 2 recruitment strategies were investigated. This article compares the drinking patterns of the disadvantaged men identified by the 2 strategies. A cross-sectional survey compared 2 strategies for recruiting disadvantaged men to a study on alcohol consumption: recruitment through general practice (GP) registers and through a community outreach strategy, respondent-driven sampling (RDS). Men aged 25 to 44 years were recruited from deprived areas in the community. The entry criterion was binge drinking (≥8 units in a single session) at least twice in the previous 4 weeks. Demographic characteristics, total consumption of alcohol, frequency of binge drinking (≥8 units in a session), and heavy binge drinking (≥16 units in a session) were measured. Men recruited by RDS drank more than twice as much as the men recruited through GP (137 units in the previous 30 days compared with 62 units; p = 0.003). They also had many more binge drinking days: more than half (57%) of men from RDS had 6 or more binge drinking days in the previous 30 days, whereas only 16% of the GP sample had 6 or more binge drinking days (p = 0.001). Many more men recruited by RDS (37% vs. 5%; p = 0.002) had more than 5 very heavy drinking sessions in the previous month (≥16 units in a session). The RDS group also had fewer alcohol-free days. The 2 sampling strategies recruited different types of drinkers. The men recruited through RDS were much more likely to engage in frequent harmful drinking. The results indicate that the 2 methods recruit different samples of disadvantaged men. Intervention studies that are only conducted through primary care may miss many harmful drinkers.

PTH-129 Development and Assessment of a Patient Information Leaflet Relating to the Harmful Effects of Excessive Alcohol Consumption. a Prospective Survey from a District General Hospital

IntroductionAlcohol abuse is a major cause of preventable liver disease world wide. Alcohol related liver disease and associated death is rising at an alarming rate whilst all other causes of...

Characteristics, circumstances and toxicology of sudden or unnatural deaths involving very high-range alcohol concentrations

To characterize sudden or unnatural deaths with very high-range blood alcohol concentrations (BACs) presenting to the Department of Forensic Medicine (DOFM) in Sydney between 1 January 1997 and 31 December 2011. Case series. Sydney, Australia. A total of 263 cases of sudden or unnatural death with a BAC of ≥0.300 g/100 ml. Case characteristics, circumstances of death, quantitative toxicology, major autopsy findings and serology. The mean age of decedents was 46.7 years and 74.5% were male. Pre-existing alcohol problems were noted in 78.7%. Deaths were due to alcohol toxicity/chronic alcoholism (35.0%), combined alcohol/other drug toxicity (14.8%), accidents (18.6%), natural disease (13.3%), suicide (11.0%), homicide (6.8%) and one case was undetermined. Alcohol was a direct, or contributory, cause of death in 84.4% of cases. The overwhelming majority (81.4%) occurred in a home environment, and deaths did not vary by day or month. The mean BAC was 0.371 g/100 ml (range 0.300-0.820 g/100 ml), being highest in alcohol toxicity/chronic alcoholism cases (0.410 g/100 ml). The most frequently detected substances, other than alcohol, were benzodiazepines (31.9%) and opioids (12.9%). Alcohol-related disease was diagnosed in 62.9% of cases. Alcohol-related pathology was prevalent across all categories of death: severe steatosis (35.3%), cirrhosis (22.5%), chronic pancreatitis (15.3%), cardiomyopathy (9.4%) and cerebellar atrophy (9.0%). Unnatural deaths with very high-range alcohol concentrations extend well beyond direct toxicity, and alcohol is causal in most cases. Those at greatest risk are middle-aged males, with long histories of alcohol problems.

Mortality following unemployment in Canada, 1991-2001.

BackgroundThis study describes the association between unemployment and cause-specific mortality for a cohort of working-age Canadians.MethodsWe conducted a cohort study over an 11-year period among a broadly representative 15% sample of the non-institutionalized population of Canada aged 30–69 at cohort inception in 1991 (888,000 men and 711,600 women who were occupationally active). We used cox proportional hazard models, for six cause of death categories, two consecutive multi-year periods and four age groups, to estimate mortality hazard ratios comparing unemployed to employed men and women.ResultsFor persons unemployed at cohort inception, the age-adjusted hazard ratio for all-cause mortality was 1.37 for men (95% confidence interval (CI): 1.32-1.41) and 1.27 for women (95% CI: 1.20-1.35). The age-adjusted hazard ratio for unemployed men and women was elevated for all six causes of death: malignant neoplasms, circulatory diseases, respiratory diseases, alcohol-related diseases, accidents and violence, and all other causes. For unemployed men and women, hazard ratios for all-cause mortality were equivalently elevated in 1991–1996 and 1997–2001. For both men and women, the mortality hazard ratio associated with unemployment attenuated with age.ConclusionsConsistent with results reported from other long-duration cohort studies, unemployed men and women in this cohort had an elevated risk of mortality for accidents and violence, as well as for chronic diseases. The persistence of elevated mortality risks over two consecutive multi-year periods suggests that exposure to unemployment in 1991 may have marked persons at risk of cumulative socioeconomic hardship.

Association of VMAT2 gene polymorphisms with alcohol dependence

Alcohol-related diseases cause significant harm in the western world. Up to 65% of the phenotypic variance is genetically determined. Few candidate genes have been identified, comprising ADH4, ALDH2, COMT, CRHR1, DAT (SLC6A3), GABRA2 and MAOA. While abnormalities in the dopaminergic mesolimbic reward system are considered important mediators of alcoholism, studies analyzing variants of dopamine receptors showed conflicting results. Other modulators of the reward system are synaptosomal genes. Among candidate genes, polygenic variants of the Vesicular Monamine Transporter 2 (VMAT2) gene locus associated with alterations of drinking behavior were published. These variants comprise single nucleotide polymorphisms (SNPs) within the promoter region and the open reading frame. In this study, we confirm the association of VMAT2 SNP rs363387 (allelic association: p=0.015) with alcohol dependence. This SNP defines several haplotypes including up to four SNPs (minimal p=0.0045). In addition, numeric effects in the subgroups of males and patients with positive family history were found. We suggest that several rs363387 T-allele containing haplotypes increase the risk of alcohol dependence (OR 1.53), whereas G-allele containing haplotypes confer protection against alcohol dependence. Taken together, there is supporting evidence for a contribution of VMAT2 gene variants to phenotypes of alcohol dependence.

Mortality from traumatic brain injury after reduction of alcohol prices: A population-based study from northern Finland

Traumatic brain injury (TBI) is the leading cause of death after trauma, and alcohol is a major risk factor for TBI. In Finland, alcohol taxes were cut by one third in 2004. This resulted in a marked increase of alcohol consumption. We investigated whether increased alcohol consumption influenced the number of fatal TBIs. All (n = 318) fatal TBIs were identified from medico-legal reports during the years 1999, 2006 and 2007 among the residents of Oulu Province, Finland. Mortality rates were compared before and after alcohol price reduction. Alcohol involvement based on the presence of alcohol in body fluids and/or alcohol-related diseases recorded in death certificates. The proportion of alcohol-related TBI deaths of all TBI deaths increased (from 1999 to 2007) among middle-aged people from 48% to 91% (p = 0.001) but decreased among young adults from 74% to 41% (p = 0.015). The overall TBI mortality rate did not increase. Fatal TBIs due to falls were significantly more commonly alcohol-related in 2006-2007 than in 1999 (p = 0.003) and accumulated among middle-aged people. After the price reduction, alcohol-related fatal TBIs increased most among middle-aged people, and they were frequently caused by fall accidents. The reduction of alcohol prices did not increase the total number of fatal TBIs. Middle-aged and elderly subjects with TBI should be routinely asked for alcohol drinking and those with hazardous drinking habits should be guided for alcohol intervention.

Chronic ethanol consumption increases cardiomyocyte fatty acid uptake and decreases ventricular contractile function in C57BL/6J mice

Alcohol, a major cause of human cardiomyopathy, decreases cardiac contractility in both animals and man. However, key features of alcohol-related human heart disease are not consistently reproduced in animal models. Accordingly, we studied cardiac histology, contractile function, cardiomyocyte long chain fatty acid (LCFA) uptake, and gene expression in male C57BL/6J mice consuming 0, 10, 14, or 18% ethanol in drinking water for 3months. At sacrifice, all EtOH groups had mildly decreased body and increased heart weights, dose-dependent increases in cardiac triglycerides and a marked increase in cardiac fatty acid ethyl esters. [3H]-oleic acid uptake kinetics demonstrated increased facilitated cardiomyocyte LCFA uptake, associated with increased expression of genes encoding the LCFA transporters CD36 and Slc27a1 (FATP1) in EtOH-fed animals. Although SCD-1 expression was increased, lipidomic analysis did not indicate significantly increased de novo LCFA synthesis. By echocardiography, ejection fraction (EF) and the related fractional shortening (FS) of left ventricular diameter during systole were reduced and negatively correlated with cardiac triglycerides. Expression of myocardial PGC-1α and multiple downstream target genes in the oxidative phosphorylation pathway, including several in the electron transport and ATP synthase complexes of the inner mitochondrial membrane, were down-regulated. Cardiac ATP was correspondingly reduced. The data suggest that decreased expression of PGC-1α and its target genes result in decreased cardiac ATP levels, which may explain the decrease in myocardial contractile function caused by chronic EtOH intake. This model recapitulates important features of human alcoholic cardiomyopathy and illustrates a potentially important pathophysiologic link between cardiac lipid metabolism and function.

Evaluation of a Pilot Training Program in Alcohol Screening, Brief Intervention, and Referral to Treatment for Nurses in Inpatient Settings

Alcohol screening, brief intervention, and referral to treatment (SBIRT) is a set of clinical strategies for reducing the burden of alcohol-related injury, disease, and disability. SBIRT is typically considered a physician responsibility but calls for interdisciplinary involvement requiring basic SBIRT knowledge and skills training for all healthcare disciplines. The purpose of this pilot study was to design, implement, and evaluate a theory-driven SBIRT training program for nurses in inpatient settings (RN-SBIRT) that was developed through an interdisciplinary collaboration of nursing, medical, and public health professionals and tailored for registered nurses in the inpatient setting. In this three-phase study, we evaluated (1) RN-SBIRT's effectiveness for changing nurses' alcohol-related knowledge, clinical practice, and attitudes and (2) the feasibility of implementing the inpatient curriculum. In a quasi-experimental design, two general medical units at our facility were randomized to receive RN-SBIRT or a self-directed Web site on alcohol-related care. We performed a formative evaluation of RN-SBIRT, guided by the RE-AIM implementation framework. After training, nurses in the experimental condition had significant increases in Role Adequacy for working with drinkers and reported increased performance and increased competence for a greater number of SBIRT care tasks. Despite some scheduling challenges for the nurses to attend RN-SBIRT, nurse stakeholders were highly satisfied with RN-SBIRT. Results suggest that with adequate training and ongoing role support, nurses in inpatient settings could play active roles in interdisciplinary initiatives to address unhealthy alcohol use among hospitalized patients.

The combination of mitochondrial low enzyme-activity aldehyde dehydrogenase 2 allele and superoxide dismutase 2 genotypes increases the risk of hypertension in relation to alcohol consumption

A cooperative role of mitochondrial aldehyde dehydrogenase 2 (ALDH2) and superoxide dismutase 2 (SOD2) to maintain the vascular function has recently been demonstrated in nitrate tolerance. The present study examined whether the combination of low enzyme-activity variants of ALDH2 and SOD2 increases the risk of hypertension in relation to alcohol consumption. A total of 444 Japanese participants in a health-screening program were evaluated. The risk of hypertension among the individuals harboring both the ALDH2*2 allele and the SOD2 Val/Val genotype was significantly higher in drinkers than in nondrinkers (adjusted odds ratio, 6.22; 95% confidence interval, 2.26-17.1; P<0.001). Among these individuals, the systolic/diastolic blood pressure also increased by 0.24/0.14 mmHg for each 1g/day increase in alcohol consumption (P<0.001/P=0.003). These associations were observed, but the degree was lower among those with the other genotype combinations (0.11/0.10 mmHg; P=0.012/P=0.001). Information about the genetic predisposition to alcohol-related diseases may thus be useful to promote lifestyle modifications for high-risk individuals.

Liver Transplantation for Alcoholic Liver Disease

Alcohol is one of the main causes of liver disease in the Western world. Total alcohol abstinence represents the cornerstone of the management of alcoholic liver disease. When total alcohol abstinence does not result in a significant improvement of liver function, liver transplantation represents the gold standard treatment for alcoholic hepatitis and end-stage alcohol-related cirrhosis. Liver transplantation for patients with alcoholic liver disease still represents matter of debate, principally due to concerns about the risk of post-transplantation recidivism and its effect on the outcome. These issues, coupled with a perception that these patients are likely to have contraindications to transplantation (e.g. extra hepatic alcohol-related disease or lack of self-care) have contributed to a reluctance of many centers to offer liver transplantation to patients affected by alcoholic liver disease. The aim of the present review is to discuss the controversies of liver transplantation for alcoholic liver disease.